Provider Demographics
NPI:1265844203
Name:ABRAMS, STACY RENARD JR
Entity type:Individual
Prefix:MR
First Name:STACY
Middle Name:RENARD
Last Name:ABRAMS
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 ARROWHEAD DR
Mailing Address - Street 2:STE 101-192
Mailing Address - City:STAFFORD
Mailing Address - State:VA
Mailing Address - Zip Code:22556-1251
Mailing Address - Country:US
Mailing Address - Phone:646-535-4068
Mailing Address - Fax:
Practice Address - Street 1:32 ARROWHEAD DR
Practice Address - Street 2:STE 101-192
Practice Address - City:STAFFORD
Practice Address - State:VA
Practice Address - Zip Code:22556-1251
Practice Address - Country:US
Practice Address - Phone:646-535-4068
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-27
Last Update Date:2014-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver